Guaranteed Healthcare

May 16, 2010

To: California Nurses Association

Via Web Form: http://www.guaranteedhealthcare.org/node/add/user-story

Ladies and Gentlemen: I am a new Medicare Part A and B beneficiary and, as a result, I can now also purchase Medicare Part D, drug coverage which has been completely outsourced and is managed entirely by private, for-profit insurance and pharmaceutical companies. I am being asked to choose from 47 MEDICARE PART D DRUG PLANS offered in Florida’s Miami-Dade County.

Each of these 47 plans offers 2 levels of “preferred pharmacy” benefits; both are further subdivided into 2 levels of “preferred generic drugs” and 4 “tiers” of brand-name drugs. Within each of these choices, there are drug- and plan-specific co-pays, deductibles, as well as monthly and annual limits. In addition, all of the 47 plans are described by a 5-star “quality” rating based upon patient feed-back. All of these differentiations provide newcomers to Medicare with over 60,000 possible Part D drug benefits choices, with annual out-of-pocket drug expenses exceeding $4,000 (Social Security Administration estimate), PLUS a $3,610 “gap” or “donut hole” in out-of-pocket expenses that occurs after Medicare's Part D has reached its own annual coverage limit and before Medicare’s catastrophic coverage is effective.

These “donut hole” expenses may or may not be covered by a "MediGap" Part D rider (available from the profit-making insurers which administer the rest of Part D for an additional premium, of course), depending on the choices made by Medicare recipients on the other Part D options. WellCare Health Plans, Inc., one of my available providers (see further WellCare information, below), provides the financial and clinical details of its healthcare benefits in a 211 PAGE “evidence of coverage” document (see http://www.wellcare.com/WCAssets/corporate/assets/H1032_FL010993_WCM_CMB...), which seniors, elderly and disabled patients, are expected to read and understand before remitting their Part D premiums.

Is anyone besides me confused, yet? Amazingly, the Social Security Administration just sent me the Obama Administration's healthcare reform program payment of $250 to cover my out-of-pocket $3,610 Medicare “gap” or “donut hole” expenses.

I am reminded of an old grammar school syllogism: $250 = A NUMBER. $3,610 = A NUMBER. THEREFORE, $250 = $3,610.

Every Medicare Part D patient is being exploited by profit-making insurance and pharmaceutical companies! To-date, my medical needs have been addressed by generic medications at a cost of $0 to $4 per medication per month (That’s not a typo; some pharmacies [e.g., Target, Wal-Mart, K-Mart and Publix] actually dispense FREE antibiotics and other generic medicines.).

REGRETTABLY, MEDICARE PART D IS NOT A BENEFIT FOR ME, IT’S AN ADDITIONAL HEALTHCARE EXPENSE! IT IS VASTLY CHEAPER FOR ME TO DECLINE TO PARTICIPATE IN MEDICARE PART D AND CONTINUE TO PURCHASE MY $4 GENERIC MEDICINES WHICH, UNDER MEDICARE PART D, BECOME MORE EXPENSIVE AND, IN ADDITION, ALSO RESULT IN DRUG- AND PLAN-SPECIFIC CO-PAYS, DEDUCTIBLES AND MONTHLY AND ANNUAL LIMITS. Repeating . . .

Every Medicare Part D patient is being exploited by profit-making insurance and pharmaceutical companies! AMAZINGLY, I AM NOW ELIGIBLE TO PARTICIPATE IN A TRULY ORWELLIAN MEDICARE ADVANTAGE PROGRAM AND A MEDICARE PART D PROGRAM, BOTH OF WHICH ARE OWNED AND OPERATED BY WELLCARE HEALTH PLANS, INC . . . One of my Medicare benefits providers (Medicare Advantage and Part D drug plans) is WellCare Health Plans, Inc., which entered into a Deferred Prosecution Agreement with the United State’s Attorney’s Office for the Middle District of Florida and the Florida Attorney General’s Office, temporarily ending further criminal prosecution in connection with an $80 MILLION FRAUDULENT BILLING SCHEME to which WellCare essentially pleaded "no contest," permitting WellCare’s executives to avoid (for now, at least) imprisonment (For further information, see Notice of Proposed Partial Settlement of Derivative Actions, Deferred Prosecution Agreement and SEC Consent & Final Judgment, all of which are available at http://www.wellcare.com/).

IN CONCLUSION, THERE CAN BE NO MEANINGFUL HEALTHCARE REFORM UNTIL ALL PROFIT IS REMOVED FROM ALL HEALTHCARE INSTITUTIONS AND OUR NATION'S HEALTHCARE INSURANCE AND REFORM PROGRAMS – INCLUDING DRUG AND OTHER ANCILLARY BENEFITS PROGRAMS - ARE ALL OWNED AND OPERATED BY NON-PROFIT ENTITIES, PUBLIC TRUSTS AND/OR UNIVERSITIES.

Sincerely, John B